Provider Demographics
NPI:1023371788
Name:WADE, ARETHA (MSED)
Entity Type:Individual
Prefix:
First Name:ARETHA
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2837 W 30TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-1803
Mailing Address - Country:US
Mailing Address - Phone:917-304-1696
Mailing Address - Fax:
Practice Address - Street 1:2837 W 30TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1803
Practice Address - Country:US
Practice Address - Phone:917-304-1696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist